This very general outline of the leading features of Syphilis will be sufficient to prove, that many difficul ties attach to the pathology of the disease, and we shall find that there is not less obscurity with respect to its treatment. And this does not arise from the s +me cir cumstances which we meet with in the management of other diseases, depending upon the obstacles that pre sent themselves to our researches into the operation of medicines on the living hotly; but here we have to encoun ter the most direct contradiction of evidence, and we are called upon to decide between the opposing opinions of those who might be supposed to possess the most unex ceptionable means of ascertaining the truth. A contro versy has subsisted for some time on the question, whe ther the same general remedies were necessary in go norrhoea as in chancre, a question which is obviously connected with the controversy respecting the identity of the infection generating the two varieties of the dis ease. With respect, however, to the proper syphilitic poison, and to its constitutional symptoms, under what ever form they manifested themselves, there was, until very lately, but one opinion, that the only remedy is mercury, the sole question for consideration being, in what way this medicine should be exhibited so as to produce the least injury to the constitution. Every one agreed that mercury possessed a specific power over the venereal poison,—that no other medicine possessed the same power ; and so firmly was this opinion estab lished, that it was esteemed a sufficient diagnostic of the presence of the disease, where the symptoms assumed a doubtful aspect, that they yielded to the action of this remedy. But, notwithstanding the supposed invaluable property of mercury as an anti-syphilitic, practitioners were aware that it is a substance which possesses an un favourable effect upon the system, if used in too large a quantity, and it was admitted that in certain cases, it was a question of extremely difficult solution, whether certain morbid appearances were to be ascribed to the disease itself or to the remedy. Still, however, no one thought of calling in question the indispensable necessi ty of mercury for the cure of Syphilis ; and the injurious effects which it seemed occasionally to produce, were attributed either to some idiosyncrasy in the constitu tion of the individual, to the injurious administration of the remedy, or to the improper management of the pa tient while under its influence. A few years ago sonic practitioners of eminence began to take a different view of the subject ; they conceived that there were certain affections, which had always been classed as syphilitic, in consequence of the mode in which they were commu nicated, and the general aspect of their symptoms, but which were capable of being cured without mercury; from this circumstance they concluded that they must necessarily be of a dill: rent nature, and they accordingly termed them pseudo-syphilitic. It then became a point of great importance to firm a diagnosis between these cases and those of genuine Syphilis ; for not only was the Pseudo-syphilis curable without mercury, but it seemed to be even aggravated by the use of this substance. As the investigation continued to be pursued, opinions arose that were still more remote from those that had been for nerly adopted ; it was now advanced, that mercury is not essential to the removal of Syphilis itself, and far ther, that a considerable part, if not the whole of the constitutional symptoms, are really the effect, not of the disease, but of the deleterious operation of mercury.— We state these points, not as articles of our own faith, for we confess our scepticism upon the subject, but as what have received the sanction of great authorities, and this not of mere theorists, but indk iduals who have been actively engaged in the details of practice, whose testimony, had it not counteracted all our former expe rience, arid opposed some of the opinions which seemed to stand upon the most incontrovertible evidence, we should have been the most lisp )sed to receive without hesitation It seems that we must regard the public sentiment on this question as now in the progress of a great revolution, the result of which it is impossible to predict ; after various oscillations of opinion, we shall perhaps filially settle in a medium state: we shall pro bably find that there are either different kinds of venereal infection, of that it undergoes certain modifications, which cause it to be differently acted upon by the same remc dy, or to require different remedies for its removal.— The general and indiscriminate use of mercury we may safely pronounce to be improper; and when we consi der the quantities in which it has been given, with so lit tle regard to peculiarity of constiution, or differences of temperament, we can scarcely doubt that its effects have been almost as injurious as those which would have re sulted from the ravages of the disease which it was in tended to cure. Yet we should be acting in opposition to the concurring testimony of the whole medical pro fession for some ages, were we not to allow of the speci fic effect of mercury over that form of Syphilis which usually presents itself to our notice, so that we may venture to assert, that if we are to give up this point, there is no one position in the practice of medicine which must not be regarded as disputable. For reasons which have been already stated, we shall not enter upon the consideration of the various local forms of the disease ; and while such a schism exists respecting the effect of mercury, it would be premature to enter upon any pa thological speculations respecting the mode of its opera ration. We shall only observe, that, independent of its anti-syphilitic power, its action on the various organs stems to be that of a stimulant, increasing their natural powers, whether of absorption, secretion, or excretion, as well as the vital functions of contractility and sensibi lity. We know not how this stimulating property can have any influence over the neutralization or expulsion of the syphilitic virus; we see no connexion between the two effects, nor can we conceive of the nature of the rela tion which they bear to each other.* This disease is characterized by general muscular debility, by livid spots on various parts of the body, sponginess of the gums, and Imincrrhage from the ali mentary canal. It is one of those diseases in which the soft parts of the body seem to have experienced a morbid change in their physical and chemical composi tion ; for not only do we find a depravation of all the functions, but, if we except the bones, there appears to be an alteration in the nature of all its constituents, both solid and fluid. The exciting causes of Scurvy are ascertained to be all those circumstances which de prive the body of its due quantity of nutrition, or weak en the action of the digestive organs, and prevent them from completing the office of chylification, such as ex ercise and fresh air ; and upon the same principle we find, that whatever depresses the spirits has a powerful influence in aggravating scorbutic affections. As its name imports, it generally makes its appearance among sailors during long voyages, when they have been for a long time without a supply of fresh provisions ; but pre cisely the same symptoms have made their appearance among the inhabitants of beseiged towns, or among ar mies who were exposed to the same deficiency of fresh food; and from a similar cause Scurvy is generally en demic in Greenland, and the other northern countries, where the inhabitants are necesssarily deprived, during the greater part of the year, of all vegetable food. The
proximate cause of Scurvy, or the way in which the ex citing causes induce the symptoms, has been the subject of much speculation, and has given rise to many patho logical hypotheses, all of which, however, we apprehend will prove to be without foundation. The symptoms which arise from the mere privation of food, do not cor respond to those which form the leading features of Scurvy, nor do we know in what way the peculiar condi tion of the soft parts which constitutes this disease can proceed from the use of salted provisions, of impure wa ter, or of a putrid state of the substances received into the stomach. 'With respect to the theories which as cribe Scurvy to some chemical change in the blood, such as a defect of oxygen, they may be considered as alto gether unfounded, and resting entirely upon the most fanciful analogies; and although the old hypothesis, which conceived the fluids to be in a putrid state, is deficient in evidence, still it appears to be less incon sistent with the acknowledged phenomena. We must therefore consider this to be one of those points of me dical theory which are not yet ascertained, and not, as far as we can judge, referable to any general principles. Fortunately, however, the want of a correct theory has not prevented us from acquiring an effectual man ner of treating the disease, for we may consider Scurvy as one of the few complaints for which we possess a cer tain specific, which in all cases removes the disease, provided no circumstance intervenes to counteract its effects. This remedy is the citric acid, which effectu ally cures Scurvy almost in its worst form, provided only that we have it in our power at the same time to remove the exciting causes. We find indeed, that when we are able to afford the patient a proper supply of fresh vegetable food, the symptoms will generally yield without the use of the citric acid, although this will, in all cases, contribute to expedite the cure. It does not appear that any other acid possesses the same power in Scurvy with the citric, except so far as they may con tribute, in certain states of the digestive organs, to aid in the process of chylification.
We may remark, in connexion with this subject, that no department of the medical profession has con ferred more benefit upon mankind than that which re spects the health of seamen. To so great a degree of perfection are we arrived in every part of the naval police, with respect to food, clothing, and discipline, both moral and medical, that scurvy is now become a comparatively rare occurrence ; the longest voyages are accomplished with little risk of disease, and even with less injury to the health, than what usually happens to the same number of men placed under the ordinary cir cumstances of civil life.
The third order of the Paratrepscs consists of the Hydropes, a set of diseases which appear to originate from an affection of the minute vessels belonging to the serous membranes that line the close cavities of the body. These vessels, in their natural state, secrete a serous fluid, which is taken up by the absorbents as rapidly as it is discharged ; but in certain conditions of the system these two operations do not proceed in ex act proportion to each other, in consequence of which an accumulation of fluid ensues, which produces the diseases in question. This accumulation may take place in the cellular texture, which pervades all parts of the body, essentially consisting of a series of small cells, that are furnished each of them with the appropri ate apparatus for secretion and absorption.
This species of Dropsy has obtained the name of Anasarca, and, according to circumstances, it either extends through the whole of the cellular texture, or occupies certain portions of it only. The exciting causes of Anasarca, as well as of Dropsy in general, are various, and not well ascertained ; it is a frequent se quel of other diseases, by which the vital powers in general, and especially the contractility of the mus cular fibre, appear to be weakened ; it is also induced by other debilitating causes, as excessive evacuations, want of proper nutrition, over fatigue or exhaustion. There is also another set of exciting causes, which ap pear to be more of a mechanical nature, and which may be all referable to a physical obstruction of the absor bent vessels; and there is a third set of exciting causes of dropsy, which are not strictly to be included in either of the preceding classes, viz. various circumstances which impede the digestive functions, especially struc tural diseases of the different abdominal viscera. In some cases indeed these affections may be attributed to the pressure of the parts, when they become indurated, upon the thoracic duct or the trunks of the absorbents, but in other cases it would seem to proceed from a consti tutional cause; the Dropsies that are produced in this way are principally those of the cavity of the abdomen, to which the term Ascites has been applied. There ap pears to be in some individuals, what may be called a Dropsical Diathesis, where serous effusion, in one or more parts of the body, is liable to take place from very slight causes, or perhaps without any assignable cause whatever.
The proximate cause of Dropsy must obviously con sist either in increased secretion or in diminished ab sorption of the serous fluid, unless we suppose that these two states can exist at the same time; we have, how ever, considerable difficulty in deciding to which of the two causes each individual case should be referred, or to determine in what manner some of the exciting causes can operate. As they are in most cases debilitating, we might conclude that the deficiency of absorption was a more frequent occurrence than the excess of secretion ; and the treatment which is found most successful in Dropsy; may probably seem to countenance this idea, yet it must be acknowledged that the pathology of the disease is altogether obscure, and that we have no direct facts to guide us in our decision. One of the most re markable symptoms in Dropsy is the change which is effected in the state of the urine ; it is much diminished in quantity, and is altered in its quality ; the proportion of the watery part to the solid contents being considera bly reduced, so as to render it thick and high coloured, and to cause it to deposit, as it cools, a copious sediment. In some cases of Dropsy the urine has been found to co agulate by the application of heat, proving that it con tains a portion of albumen ; and as the presence of albu men has been conceived to indicate a different condition of the system from that which prevails in the more ordinary kinds of Dropsies, considerable importance has been at tached to this circumstance, both in a pathological and a practical point of view.